Doran Stephen E, Vukov Joseph M
Section of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Philosophy, Loyola University Chicago, Crown Center for the Humanities, Chicago, IL, USA.
Linacre Q. 2019 Nov;86(4):285-296. doi: 10.1177/0024363919840129. Epub 2019 May 20.
Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead.
Before a person's organs can be used for transplantation, he or she must be declared "brain-dead." However, sometimes when someone is declared brain-dead, that person can be maintained on life-support for days or even weeks. This creates some confusion about whether the person has truly died. For patients who have a severe neurologic injury but are not brain-dead, organ donation can also occur after his or her heart stops beating. However, this protocol is more ambiguous and lacks standardized protocols. We propose that before a person can donate organs, he or she must first be declared brain-dead, and then his or her heart must irreversibly stop beating before organs are taken.
根据神经学标准宣布死亡后延长的生存期，使得这种判定方法的有效性产生了模糊性。这种模糊性使世俗和无异议的天主教作者之间的争论持续存在，他们质疑神经学标准对于宣布器官捐献者死亡是否足够。心肺标准越来越多地用于不符合脑死亡标准的器官捐献者。然而，心肺标准存在利益冲突问题、候选资格的任意标准以及缺乏器官获取的标准化方案等困扰。将神经学和心肺标准合并为一个单一方案将减轻两者的弱点，并在生物学和道德上更确定地表明未配对重要器官的捐献者确实已经死亡。
在一个人的器官可用于移植之前，他或她必须被宣布为“脑死亡”。然而，有时当某人被宣布脑死亡时，那个人可以在生命维持系统上维持数天甚至数周。这就产生了关于这个人是否真的死亡的一些困惑。对于有严重神经损伤但未脑死亡的患者，在其心脏停止跳动后也可以进行器官捐献。然而，该方案更加模糊且缺乏标准化方案。我们建议，在一个人能够捐献器官之前，他或她必须首先被宣布脑死亡，然后在摘取器官之前其心脏必须不可逆地停止跳动。
